If a pregnant woman doesn’t feel safe pushing her baby out, should she be forced to? In theory, of course not. But today Birthrights – the charity promoting human rights in childbirth that I run – released a report showing the worrying treatment of British women who request a caesarean-section birth.
Transparency about what happens to women who ask for a C-section is long overdue. Since its revision in 2011, the Nice best-practice guidance has rightly recognised that women should always be the primary decision-makers in childbirth, while also protecting the right of individual doctors to decline to support an individual who requests a C-section on non-medical grounds. Despite this guidance, Birthrights’ advice service now handles more requests for support on this issue than on any other.
Many of those we help are trying to give birth by C-section after enduring previously traumatic vaginal births, physical or mental ill health, or are survivors of sexual abuse. Others have carefully examined the evidence available – much of which is far from clear-cut – and made personalised decisions that a planned C-section will give them and their babies the best chance of an emotionally and physically healthy start.
Their decision-making processes and desire for kindness, clarity and control at a transformational time are no different from those of the many others we support as they try to access home, vaginal or midwife-led births. Pregnant women are often desperate, deeply worried and frightened by the time they seek our advice. Some describe feeling forced to give birth vaginally against their will and wishes. And many speak of a complete lack of humanity from their caregivers when this issue comes up.
The publication of our research demonstrates that nearly three-quarters of NHS trusts do not have written guidelines that clearly commit to upholding a woman’s autonomy in this area. Women often find it hard to get accurate information about local policies, and face lengthy, anxious waits for decisions from multiple clinicians on whether their request will be granted.
Some trusts have even implemented policies that effectively ban maternal-request C-sections, which Birthrights believes is contrary to Nice guidance and are potentially in breach of the trusts’ human rights obligations. In these regions, women are forced to travel miles to different hospitals to have their requests granted – something likely to have the greatest impact on those with complex medical or social circumstances, who rely on public transport or who don’t have family support. Our data, paired with the distressing stories we hear regularly from pregnant women, demonstrates that the majority of trusts are not consistently providing compassionate, woman-centred care for those requesting a C-section.
I didn’t expect to be campaigning for C-section rights when I became pregnant for the first time nine years ago. Like many other activists, I was initially influenced by my personal experiences of birth and parenting. My children were both born in our home and though my hours of childbirth were tinged with pain and fear, they were also enjoyable, positive and powerful. I was treated respectfully, given choices, and granted the bodily autonomy that is every woman’s right – though sadly not many women’s experience.
The desire to promote a birth ideology tied to something that worked for us personally – or the attempt to steer others away from traumatic experiences we have had ourselves – is seductive and understandable. But I have come to believe that promoting a particular way of giving birth as the best or right way simply divides us, and stops progress on that which is most important – the complex and individual needs of each woman being listened to and met as best they can be.
Influenced by their personal medical, cultural, social and other factors, women make different birthing decisions – but ultimately for deeply similar reasons. That I chose home birth does not make me less of ally to those who need a C-section. It makes no sense to continue to pit women against each other in these discussions and I am grateful for the chance to defend the rights of all women giving birth.
I believe we all deserve unbiased and personalised pathways in maternity care alongside evidence-based information to allow us to make the best decisions in our individual circumstances. It is clear that women requesting C-sections meet judgmental attitudes, barriers and disrespect more often than they find compassion and support. And I worry that this lack of respect for patients’ dignity could have profound negative consequences for their emotional and physical safety.
I hope that our report, and the online map that accompanies it, will give women information to help them choose a maternity care provider and act as a catalyst for transparency and consensus on this issue, encouraging national bodies, service-users groups, campaigners and clinicians to come together to promote policy and guidelines on maternal-request C-section birth that truly meet the needs of women.
• Rebecca Schiller is the director of Birthrights, the charity promoting human rights in childbirth
